Wherein a surgeon tells some stories, shares some thoughts, and occasionally shoots off his mouth. Like a surgeon.

Tuesday, May 27, 2008

Looking In

After my recent "Family Guy" post, and a comment by the estimable bongi, I've been thinking about sharing. In the new-age sense of the term: letting people in on what you think or do or feel or other nerve-grating uses of the word. Y'know: "Thanks for sharing..."

I digress.

What I mean is that the esoteric world of surgery, so dramatic, and intimately knowable only to a small and generally comprehending audience, is quite isolated from those with whom we might most like to share it: family, close friends. I always wanted my son to see me do an operation (my wife did, once, when I was in training. But it was a small deal, and I wished she could have seen something more complicated). As much a part of my life as it has been, and as much as it took me away from his, I'd have loved to have had him watch it, just once. Demonstrate; explain. Perform, impress. Yet it's nearly impossible for a surgeon really to let people from the outside in on what it is that he or she does. I suppose it's not unique, but I think in most other fields it's more possible, easier to gain access. As thoroughly as it envelops us, as proud as we might be of what we've accomplished in learning it, what we do in the operating room must remain hidden from those we love. The fascination, the beauty, the talent (if that it be!): forced, by its nature, into secrecy. How many are the times I've wished it were otherwise. One of my proudest days was when my father-in-law, an anesthesiologist, came to town and spent the day in the OR with me. But he had business there. He's the only one.

Which reminds me of a story.

After years as a trial lawyer, my dad was appointed to the bench (meaning, to be a judge). As his days in front of the bench were winding down, I -- a freshman in high school, as I recall -- mentioned to him that I was sorry I'd never seen him in action, in court. Okay, he said, how about we have you come? Great!! Don't get your hopes up, he warned. It's pretty boring stuff, not like Perry Mason. As it turns out, he was entirely wrong. Other than the fact that the case was about a taxi and traffic, it was exactly like Perry Mason.

Dad was defending the taxi driver. There'd been some sort of accident in which the passenger was (not very seriously) hurt. It had been determined that the taxi was not speeding, but in Oregon there's this thing called the "basic rule:" when conditions warrant it, speed limits don't apply. If it's snowing, driving at the posted speed limit of, say, 35 mph, might be too fast. Common sense. So the plaintiff was on the stand, being interviewed by her attorney, and at some point claimed it had been raining. I saw the taxi driver lean over and whisper something to my dad. In turn, my dad leaned over and whispered to his Della Street, (actually, her name was Frances) who got up and left the courtroom.

When it was Dad's turn to cross-examine, after taking plenty of time, he got around to asking the witness about the rain: You're certain it was raining? Oh, yes. Do you recall seeing puddles in the street? I sure do. Splashes. Were the taxi's windshield wipers on? Yes, they were. People on the streets, using umbrellas? Absolutely. Umbrellas up the ass.

While he was doing this, Dad paced around the courtroom doing his tongue-of-death maneuver. It's hard to describe. When he was angry, my dad stuck his tongue part way out, flexing it (if that's the word) so that it became as thick as a Porterhouse steak, and clamped down like he'd bite it off if it weren't so impressively muscled. To us kids, it was a sign to head for the hills. One can only wonder what the hell the jury thought.

The doors at the back of the courtroom banged open, some heads turned that way. Papers in hand, the barest hint of a smile on her face, in trundled Della Street. Excuse me, Your Honor, my dad asked. May I have a moment? A nod of the judge's head, a back-flick of his hand. After Dad and Della conferred, Dad looked over the papers, and handed them to the judge. May I have these entered into the record, marked as an exhibit? So ordered.

Tongue active but unbloodied, Dad gave the papers to the witness, and asked her to read the title. They were, she read, from the Weather Bureau. The date? The day of the accident. And what is this column here? Precipitation. Can you find the heading for rainfall? Yes, here. And what does it say? Zero. Do you see the place for hail? Yes. Is any listed? No. Was there any snow that day? No. Was there any precipitation at all, precipitation of any kind? I guess not. Thank you. No more questions.

Well, yeah, okay. No sobbing confession on the stand, no close-up of those buggy eyes. There was no da dah, da DAH. But otherwise, it followed the script pretty well. I was impressed.

Later, I mentioned the tongue thing to Dad. Did he know he was doing it? Sure, just to impress the jury. That I didn't believe, not for a minute. Too creepy for that. Way too creepy.

gdad: funny you should mention asking people who worked with me. There was just some communication between JB and Joanie, who scrubbed with me for decades: he didn't believe my claim of a twelve minute gallbladder with xrays, so I gave him her address and there was an exchange of excellent letters... (he's now convinced!)

As to a "tell" I'd say it was to demand the music go off and everyone stop talking, which happened only when the soup was deep and thick.

I'm here at my internship in Portland, researching an equitable forum choice doctrine, about which your father authored a key Oregon opinion. So the two of us have been spending some time together.

When I saw his name on the case, I asked one of the senior partners here at the firm about him. Apparently "Schwab" was at bit of an icon. He was famous, for example, for turning his back on counsel when he thought they were being particularly wasteful of his judicial energy. He sat in the center of the bench, and when his patience wore thin, he swiveled 180 degrees in his chair and waited silently for counsel to wrap it up. Which I imagine happened rather quickly.

A second story pertains to the appointment of circuit judges. The story goes that when your father's circuit was created, the county bar associations were asked to appoint the first round of judges. The result was a bench comprised of experienced, able trial lawyers, including your father. The next round were elected, however. One judge in particular (the heir to some famous Oregon pioneer) had more history attached to his name than ability. After arguments, the judges sat in conference, divided up the opinions, discussed the cases, etc. Your father's voice could occasionally be heard throughout the entire courthouse, telling the younger elected judge what a worthless f-ing idiot he thought he was.

When I expressed my surprise to the attorney here who told me the story, he said, "Oh, that's just the way Schwab was. I remember being a young attorney overhearing those rants. I remember dreaming of someday reaching a point in my career where I would be raise my voice and tell people exactly what I think with total impunity. Actually, I still dream about that."

patrick: what a great comment! Thank you very much!! I'm aware both of the high regard in which he was held as a judge (the Oregon Court of Appeals was known nationally for the rapidity of its turn-around times: in fact he spoke to other courts and state legislatures about his court, having been one of the designers of it and its first Chief Judge), and of the trembling he sometimes engendered.

From Patrick's comment it does sound like he wasn't just putting on a show for you. What a sweet story, really. (Puts me in the mood to dig up some Gardner.)

I can't say I've ever wanted to see surgery being done. I was scared enough by the wetroom at uni. Actually - by the *idea* of the wetroom. I never went there - but had a few courses close to it and got to share the smell. Some of the environmental chemistry students had the pleasure of visiting briefly in a course where they were to sample the airquality - they (or at least some of them) worked on a DON'T LOOK schedule.

Same thing happens with me. There's no way anyone in my family -- no one besides the occasional med student -- would ever get to see me work. I've had some pretty sweet interviews of late, but of course the essence of the interaction wouldn't be the same with a witness.

We have to get over ourselves and learn to accept our own good opinions of ourselves, without the need to show off for others.

I knew most of my surgeon's "tells", and the anesthesiologist's as well. Figuring that stuff out is half the battle as a circulator. :-)

At the same time I was working in the OR I was also working as an actress. Talk about two divergent paths: one totally behind closed doors, the other out in front of a huge audience. And I never felt like I could adequately describe one experience for my friends in the other.

My dad was a career police officer. I rode with him a couple of times. Watched him do night court judge when he was desk sargent. He knew people like open books. That was a spooky thought. He had a way of turning on anger and turning it off that scared the poop out of me!! He was amazing when working with people. Best field psychologist I ever met or saw.

He loved to show off, and could tell the most amazing stories. He saw and did things I never knew about, and still don't. I saw him burning his uniform one day..... much later he told me about removing a man that had been dead a week. He told me about a fellow he tried to drag out of a firey wreck... and couldn't....

He made me promise/swear that I wouldn't be a policeman. Unless it was federal. I kept that promise. I wonder though, if it's normal for us to measure ourselves by the same line of work our dads did. I always felt he was a bigger, better man than me, because I didn't follow in his steps. I'm closer to my kids than he was to us, but there is still that haunting question..... Could I hack it? Am I a bit yellow for not trying? Makes me wonder.....

About Me

Boring, Unoriginal, but Important Disclaimer:

What I say here is as true as I can make it, based on my experience as a surgeon. Still, in no way is it intended as specific medical advice for any condition. For that, you need to consult your own doctors, who actually know you. I hope you'll find things of interest and amusement here; maybe useful information. But please, please, PLEASE understand: this blog ought not be used in any way to provide the reader with ideas about diagnosis or treatment of any symptoms or disease. Also, as you'd expect, when I describe patients, I've changed many personal details: age, sex, occupation -- enough to make them into no one you might actually know. Thanks, and enjoy the blog.